Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 35-07-5061 | OH |
N | 207RN0300X | Nephrologist | 37649 | KY |
NPI | 1073557500 |
---|---|
Provider Name | Dr. John Hergenrother |
First Address | Cincinnati, OH 45219-2906 |
Second Address | Cincinnati, OH 45219-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 02/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2330203 | (05) | OH |
390008623 | MEDICARE RAILROAD (01) | OH |
64054018 | (05) | KY |
H58417 | (02) | OH |